This web article is based on the Trend Scenario and the Thematic Foresight Studies. The substantiation for the texts, numbers and figures presented here can be found in these documents, unless indicated otherwise. The Trend Scenario and Thematic Foresight Studies show how our public health situation and health care sector will develop over the next 25 years if we pursue our current course and do not take any additional measures. This approach makes it possible to map out the societal challenges for the future.
Health care expenditures are increasing due to demographics and technology
Health care expenditures are increasing by 2.9 percent per year on average, reaching 174 billion euros in 2040. That is double the amount compared to 2015. A third of this growth is the result of the ageing population and population growth, while two-thirds can be attributed to other factors such as technology. Technological developments, including (often expensive) new medicines, are responsible for a sharp increase in health care expenditures for for example cancer treatment. In 2040, health care expenditures for cancer treatment will be more than four times the amount spent in 2015. There is a complex relationship between technology and health care expenditures. Technological innovations in health care could reduce costs, but that does mean using cost-effective interventions and replacing old technology. That puts serious strain on the way health care is organised.
Health care expenditures will double to 174 billion euros in 2040
Health care expenditures are increasing by 2.9 percent per year on average, reaching 174 billion euros in 2040. That is double the amount compared to 2015. Health care expenditures per person will increase from 5,100 euros in 2015 to 9,600 euros in 2040. Expenditures are expressed here in 2015 prices, and include both collective and private expenditures. Health care expenditures expressed in Gross Domestic Product (GDP) percentage will increase from 12.7 percent in 2015 to 16.4 percent in 2040. This based on a projected growth in GDP of 1.8 percent annually. One-third of increased health care expenditures is due to the ageing population and the overall increase in population. Two-thirds can be attributed to other factors, such as technological progress. Technology includes new medicines, but also new devices for diagnostics and treatment, such as scanning devices and surgical robots.
Healthcare expenditures for disease groups show most rapid growth in costs of cancer treatment
In 2040, the group of psychological disorders, including dementia and intellectual disabilities, will continue to represent the group of diseases involving the highest spending. In the 2015-2040 period, expenditures for cancer treatment will grow most rapidly, averaging 6 percent annually. In 2040, health care expenditures for cancer treatment will be more than four times the amount spent in 2015. The percentage of this diagnostic group in total health care expenditures will increase from 7 percent in 2015 to 14 percent in 2040.
One-sixth of the increase in cancer expenditures is attributable to demographic trends, while five-sixths can be attributed to other factors such as technology. In this context, technology primarily refers to new medicines. This trend shows a divergence between the increase in cancer occurrence and health care expenditures related to the disease. The same pattern can be seen for cardiovascular diseases, although it is less pronounced. In dementia, the degree of occurrence and health care expenditures broadly run parallel to each other (see figure).
Indicator(s) used: the number of people with a specific disease and the absolute health care expenditure on these diseases, 2015 - 2040.
The number of people with a disease is calculated differently (e.g. year prevalence or 10 years prevalence), depending on the disease. Cardiovascular diseases consist of stroke, coronary heart disease, cardiac arrest, valve problems, heart failure and cardiac arrhythmias. Dementia includes the ICD codes F01-F03, G30. Cancer includes the whole cancer ICD-chapter.
Source(s) used (in Dutch): Cost of Illness Studies by RIVM, NIVEL Primary Care Database; Dutch Cancer Registration.
Looking at expenditures for various health care sectors, the category for care for older people will grow most rapidly
Comparing all health sectors, expenditures for care for older people are increasing most rapidly: from 20 percent of the total health care expenditures in 2015 to 25 percent in 2040. From an absolute perspective, this will mean an increase from 17 billion to 43 billion. About three-quarters of this growth can be attributed to demographic trends. Health care expenditures for people over 65 will increase from 44 percent of the total in 2015 to 59 percent in 2040.
There is a complex relationship between health care expenditures and technology
Technological developments explain an important part of increased health care expenditures. Technological innovation has two sides in that context. Historical trends show that technology leads to more health care expenditures. But using technological solutions can also save on costs. There is a complex relationship between health care expenditures and technology, and multiple mechanisms play a role in that. For instance, new technology often creates more health care demand. Consider less-invasive operating techniques that are also suitable for fragile patients. In addition, the positive aspects of care in general and care technology in particular are also having an impact outside the health care sector, such as increased workforce participation. These effects are not included in the evaluation of the use of new care technology. Technological options in health care are also strongly influenced by developments outside the health care sector. That makes management difficult.
Technology does not automatically save on costs
A prerequisite for achieving cost reduction by using new technology is by focusing on applying cost-effective interventions and discontinuing funding for obsolete technology in good time. That type of management requires active policies. New technologies also allow for the shift of expensive second-line care to the lower-cost first line. This will lead to cost reduction, provided that ‘old’ types of care will be phased out. This does not happen automatically, because it not only shifts the work, but also the funding. This might result in resistance, as this will lead to loss of income in second-line health care. There are also innovations which could actually lead to a shift in care from the first line to the second line, because it leads to more complex care. That shift from ‘expensive’ to ‘cheap’ does not happen automatically, and puts serious strain on the way health care is organised.
Bedside care is difficult to automate
Despite all the technological progress, health care is still largely a human-driven profession, representing 1.4 million jobs in the Netherlands. In contrast to agricultural, industrial and commercial services, many jobs in health care simply cannot be replaced by an automated solution. That factor ensures that productivity in that sector will not increase as strongly as in other sectors, which will make the use of workers relatively more expensive. There is already a shortage in the workforce in certain domains, for instance geriatric care, and the ageing population will result in an increase in health care demand. Combined with the fact that much of health care simply cannot be replaced by an automated solution, guaranteeing sufficient staff to provide bedside care will be a key concern for the future.